Patient-reported outcomes (PROs) reflect the experience of health and healthcare as reported directly by the patient. There is increasing evidence that capturing PROs will be an essential component of quality measurement, quality improvement, and patient engagement in care and research. The Patient-Reported Outcomes Measurement Information System (PROMIS) toolset is a PRO survey system that utilizes computer adaptive testing to provide precise measurements with a minimum number of questions, often shortening conventional PRO surveys by 10-fold or more. Unfortunately, previous attempts to integrate PROMIS into Electronic Health Records (EHR) have not integrated optimally into EHR workflows. Working with the PROMIS software team, NUCATS has developed a seamless integration of the PROMIS toolset into our local Epic EHR installation. This experience has convinced us that tight workflow integration brings many benefits and greatly facilitates incorporation of PROs into both quality and clinical research projects. The response to our presentations of this work has also demonstrated that there is a need for similar integration at many CTSA sites. This project represents a collaboration of nine CTSA sites: NU, University of Chicago, University of Illinois at Chicago, University of Alabama at Birmingham, University of Kentucky, University of Florida, University of Utah, Harvard Catalyst CTS, and Southern California CTSI. These sites utilize a variety of different EHR platforms. The team includes the developers of the PROMIS toolset software, experts in EHR integration, and experts at SMART and FHIR. The goal of this project is to develop and evaluate a suite of software tools that will allow all CTSA sites to integrate PROMIS tools directly into their EHRs. To achieve this, we will develop software to support tight integration into the two most common academic medical center EHRs--Epic and Cerner. We will develop a generalized integration of the PROMIS toolset, utilizing the SMART-on-FHIR standard, that can be implemented in multiple EHR platforms. Finally, we will implement and evaluate these software solutions across a number of diverse CTSA sites both within and outside of the project team CTSA sites.